Contraceptive Uptake And Adherence Amongst Post Abortion Women Following Contraceptive Counselling By Physicians And Midwives In Kisumu County, Kenya

ABSTRACT Complications of unsafe abortion and those of incomplete abortion, led to 120,000 Kenyan women receiving Post Abortion Care (PAC) in 2012, and of these women, 70% had not used contraception before pregnancy and repeat abortion is common. The aim of the research was to explore contraceptive uptake, adherence to contraceptive use, associated factors and satisfaction with care among women seeking post abortion-care (PAC) in Kisumu, Kenya and to determine the technical competence of midwives as compared to physicians in terms of contraceptive counselling. The study (included 128 women in the quantitative study and 20 in the qualitative study) nested in a larger randomized controlled trial, where women sought PAC at two public hospitals in Kisumu, in October 2015–September 2017. The 128 women randomly assigned to a midwife or a physician for PAC, including contraceptive counselling, and followed-up after 7–10 days and three months. Associated factors for contraceptive uptake analyzed with binary logistic regression, and contraceptive method choice, adherence and satisfaction level examined by descriptive statistics, using IBM SPSS Statistics for Windows, Version 22.0 while framework analysis was used to analyze qualitative data. The results showed that of the 128 randomly selected PAC-seeking women, 95.3% accepted the use of contraception. The women were between the age of 15 and 40 years. Methods chosen after contraceptive counselling were hormonal injections (39%); contraceptive pills (33.3%) condoms (22.8%), hormonal implant (4.1%) and fertility (0.8%). None chose intrauterine device (IUD) or a permanent contraceptive method. After 3-months, follow-up 79.7% retained the chosen contraceptive method while 20.3% had changed the chosen type of contraception to another method. Women (96.1%) still used contraception, and were satisfied with the chosen contraceptive method (x2= 1.0112, df = 3, p =0.799). The twenty (20) women in the qualitative study selected from the 128 who had participated in the quantitative study, to determine their experiences of contraceptive counselling that was provided during counselling and provision of contraceptive methods. Women generally had positive experiences with contraceptive counselling from service providers and it helped them in making informed choice of contraceptives and were able to discuss the contraceptives in general and more in detail on the method of choice. Follow up visits well planned and women could visit facilities anytime they had a problem following post abortion care, before planned visits women were given a call a day before to remind them of visits. The counselling they received was effective in supporting contraceptive uptake and adherence. In conclusion, the study shows that there were no statistical difference in contraceptive uptake and adherence provided by midwives (98.5%) as compared to physicians (93.5%) in providing contraceptive methods to post abortion women effectively. Women have good experiences during interaction with midwives and physicians during counselling. Since the post abortion women were satisfied with the contraceptives counselling provided and services dispensed, meaning both physicians and midwives can provide services effectively therefore recommend the midwives to counsel and provide contraceptives to post abortion women.